FALL 2023
NEWS
KNEE TREATMENT RESEARCH-BASED INSIGHTS THAT MAXIMIZE PATIENT OUTCOMES
LESS PAIN, MORE PROGRESS AFTER TKA: A MULTIMODAL POSTOPERATIVE PROTOCOL Regaining range of motion (ROM) and function after total knee arthroplasty (TKA) requires effective management of postoperative pain. Shelbourne Knee Center’s multifaceted TKA pain management and rehabilitation protocol facilitates early initiation of physical therapy (PT) and promotes a successful recovery while minimizing opioid exposure and associated risks. “The ability to participate in our physical therapy regimen is crucial to the patient’s recovery,” says Rodney Benner, MD, an orthopedic surgeon at Shelbourne Knee Center. “It’s very difficult for them to do that if they have uncontrolled pain.”
A Research-Backed Protocol Shelbourne Knee Center’s TKA postoperative pain management and rehabilitation protocol combines modalities to prevent swelling and pain during the first week, PT, limited or no use of opioids and patient education. The protocol is based on lessons learned from the center’s research on pain management after anterior cruciate ligament
(ACL) reconstruction, which spans 41 years, Dr. Benner’s TKA research and advances in postoperative pain management. Shelbourne Knee Center implemented the protocol for TKA patients in 2007 and has been studying the results and enhancing the protocol since then. A key goal is to prevent postoperative swelling. This is done via seven days of bed rest, use of a continuous passive motion (CPM) machine, cold and compression, and TED hose. While bed rest may seem shocking to most orthopedic surgeons, early ambulation after TKA increases swelling and pain. This hampers early PT, which can result in a loss of range of motion that’s difficult to overcome. A study of 641 TKAs in 463 patients conducted by Dr. Benner and Shelbourne Knee Center physical therapist Sarah Eaton, PT, DPT, ATC, LAT, found that seven days of postoperative bed rest improved recovery of ROM without increasing common complications.1 ROM loss of < 1% for Shelbourne Knee Center patients was lower than the
1.3–5.8% rate of stiffness seen in a systematic review by Zachwieja et al.7 The center’s rates of deep vein thrombosis (0.3%), infection (0.6%) and manipulation under anesthesia (0.8%) were lower than or similar to those in the literature. During bed rest, patients use the CPM machine and the Knee Cryo Cuff, wear TED hose and begin PT exercises. CPM positions the knee above the heart, preventing a hemarthrosis in the knee joint. Initially, Shelbourne Knee Center used CPM to promote healing. The center’s research found that CPM also increased ROM, decreased pain and the need for pain medications, and decreased the rate of deep vein thrombosis.2,3,4,5 “CPM really calms down patients’ pain, and they appreciate the improvement it provides in the early days after surgery,” says Dr. Benner. The mid-thigh TED hose is applied over postoperative dressings in the operating room at the end of the procedure, along with the Knee Cryo Cuff, developed by K.Donald Shelbourne, MD, in collaboration CONTINUED ON NEXT PAGE
Shelbourne Knee Center
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| FixKnee.com 1 9/21/23 3:00 PM